Neurovascular Assessment

Question 1

What is Neurovascular Assessment?

Answer 1

• Neurovascular assessment of the extremities is performed to evaluate sensory and motor function and peripheral circulation
• Observations include pulses, capillary refill, skin colour and temp, sensation and motor function
• Assessment findings of affected extremity must be compared to those of unaffected extremity, even if only subtle changes

Question 2

Neurovascular Assessment: Pulses

Answer 2

• While palpating pulses of each extremity, assess the most distal pulses that are accessible and parallel
• Assess for weak, diminished pulsations or absence of pulse
• Inequality at assessment points is an abnormal finding; can indicate poor perfusion

Question 3

Neurovascular Assessment: Capillary Refill

Answer 3

• Assessment by pressing on nail beds or skin of affected extremity
• Capillary refill of 3 seconds or less is normal for an adult
• Refill time of greater than 3 seconds can indicate abnormal perfusion

Question 4

Neurovascular Assessment: Skin colour and temp

Answer 4

• Temp changes can be detected more readily by using back of the hand
• Coolness or paleness of skin can result from diminished arterial blood flow and warmth can be caused by venous insufficiency
• Skin that is shiny and pale suggests pressure is building around affected area→ requires immediate intervention to prevent vascular compromise to muscles and nerves

Question 5

Neurovascular Assessment: Sensation and Motor Function

Answer 5

• Patients complaining of tingling, pins and needles or numbness in an extremity should be investigated immediately
• Abnormal evaluation of patients sensory function can be related to nerve involvement or compromised blood flow
• Trauma, unrelieved pressure and ischemia can cause permanent damage to muscles, nerves and vessels
• Patient’s ability to perform specific movements is key indicator of motor function of specific nerves

Question 6

Assessing the 6 P’s
6 P’s of neurovascular assessment alert you to specific problems- first 3 are early signs of trouble, the last three are late

Answer 6

Pain 
Pallor 
Parasthesia
Pulse
Polar
Paralysis

Question 7

6P’s: Pain

Answer 7

• May be related to increasing edema, nerve injury of possible DVT
• Signals beginning of muscle ischemia

Question 8

6P’s: Pallor

Answer 8

• Indicates disruption of arterial blood flow; usual; from pressure
• Skin will become pale white in light-skinned patients or ash grey in dark skin patients

Question 9

6P’s: Paresthesia

Answer 9

• Suggests nerve compression has disrupted nerve function

- Patient will complain of numbness or tingling in his hands or feet

Question 10

6P’s: Pulselessness

Answer 10

• Occurs when arterial blood flow is disrupted

- If this appears postoperatively; tissue damage has already occurred

Question 11

6P’s: Polar

Answer 11

• Refers to coolness of limb; late finding that reflects disrupted arterial blood flow